Predictors and behaviors of maintenance: An overview

Originally written in 2010 by guest blogger Angela Baldo.

If I hear one more person say, "just keep doing what you did to lose the weight," I think I will scream.

I have gained and lost 100+ pounds twice -- losing weight wasn't the problem, but keeping it off sure was. Because while similar to weight loss, maintenance has subtle, important differences, both in procedure and in psychology. This is the whole point of the Second Helping Online, and today I will focus on some specific strategies that have been shown to be statistically associated with successful weight management after loss.

One of the most exciting aspects of emerging weight loss maintenance research is that it can help us understand what kinds of things we need to do in order to keep the weight off. The big difference between this approach and others I have seen is that there is actual scientific research backing up the claims, rather than some "expert" speaking about his or her individual personal experience or philosophy.

National Weight Control Registry team member J. Graham Thomas (interviewed recently by our own Russ Lane) published an article last year with Rena Wing in Medicine and Health Rhode Island, the official member newsletter of Rhode Island Medical Society. In this paper Thomas outlined the strategies that are most statistically associated with weight management. Here are the best predictors of keeping weight off: 1. Longer duration of weight loss maintenance (more than 2 years 2. Dietary consistency 3. Less fast food consumption 4. Less TV viewing 5. More frequent breakfast consumption 6. Lower levels of depressive symptoms and dis-inhibited eating Key behaviors associated with weight maintenance are: 1. Activity levels of over 200 minutes per week (at least for women in the cited study) 2. High levels of dietary restraint, such as: Deliberately taking small helpings , avoiding certain foods, counting calories 3. Having lower levels of depressive symptomology 4. Controlling overeating

Yes, this means that it's important to continue logging and/or controlling eating. It's important to keep exercising. A lot. If you want to keep the weight off, these behaviors need to continue.

One of the more interesting behaviors listed was controlling depression. This means getting help in the form of therapy and/or antidepressants, if necessary. It is not a factor one usually hears about in terms of controlling weight, but it makes sense: how is a person going to make rational, healthy decisions while suffering from mental illness?

Along with summarizing the strategies taken by successful maintainers, the article discusses how to teach these strategies. One of the most important factors associated with weight management was frequent weighing and using that information to regulate behavior. Thus, as with any feedback system, the best control is achieved by: 1. Frequent monitoring 2. Immediate correction Given these research findings, I find it stunning that there are no dedicated evidence-based weight management programs.

Most programs focus on the weight loss, and tack on a slipshod "management" guide at the end as an afterthought. At best they tend to be based on the personal philosophies of "experts." I would love to see a program that leads people through the transition from loss to management, walking that delicate tightrope between exploring the wonderful new options that a healthy size offers in life while staying grounded and accountable to maintenance. There are plenty of weight loss programs out there, but why are there none oriented specifically toward weight management after loss? Is it because weight management doesn't pay as well as loss? Management isn't as exciting as loss? So few people focus on management that there isn't a market for it? A combination of these reasons? People do successfully lose weight using weight loss programs. But unfortunately they also tend to usually gain back the weight. Is it any wonder?

I would like to see this changed. Please, someone, develop an evidence-based program. But please, develop it! Not only for me, but for the thousands upon thousands of us who spent so much time and energy (and even money) on getting the weight off. It is too important in terms of our health and our quality of life, just to let the pounds slip back on. If they do come back, I won't be able to continue enjoying things like kayaking. 

Russ Lane